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Kurihara K, Shinzato H, Takaesu Y, Kondo T. Drinking behavior patterns may be associated with persistent depressive symptoms after alcohol abstinence in alcohol use disorder. Neuropsychopharmacol Rep 2024; 44:381-388. [PMID: 38463015 PMCID: PMC11144622 DOI: 10.1002/npr2.12429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
AIM This study examined the association between drinking behavior patterns and depressive symptoms after alcohol abstinence in patients with alcohol use disorder (AUD). METHOD We recruited 102 AUD inpatients with baseline depressive symptoms, indicated by scores ≥6 on the Quick Inventory of Depressive Symptomatology Self-Report Japanese Version (QIDS-SR-J) pre-detoxification. Post-4-week abstinence, remission was defined as QIDS-SR-J scores <6. Patients were classified into remitted (n = 51) and persistent (n = 51) groups. Comparative analyses were conducted using patient profiles and the Drinking Behavior Pattern 20-item Questionnaire (DBP-20). Logistic regression identified factors related to post-abstinence persistent depression. Receiver operating characteristic curve analysis determined DBP-20 cutoff scores differentiating between persistent and remitted depression. RESULTS The persistent group exhibited higher scores in the DBP-20 "coping with negative affect" subscale. Logistic regression showed low education, unemployment, and using alcohol for coping as significant factors for persistent depression. Conversely, an automatic drinking pattern indicated natural remission post-abstinence. A subscale score of ≥8 in alcohol use for coping, especially among unemployed patients, predicted persistent depression (sensitivity 86.8%, positive predictive value 73.3%). CONCLUSION Unemployed patients with AUD using alcohol to cope with negative affect may experience residual depression even after detoxification. In contrast, patients with AUD with predominantly automatic drinking behavior may exhibit natural remission post-abstinence.
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Affiliation(s)
- Kazuhiro Kurihara
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Hotaka Shinzato
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
| | - Tsuyoshi Kondo
- Department of Neuropsychiatry, Graduate School of MedicineUniversity of the RyukyusOkinawaJapan
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2
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Porreca A, De Carli P, Filippi B, Bakermans-Kranenburg MJ, van IJzendoorn MH, Simonelli A. Maternal cognitive functioning and psychopathology predict quality of parent-child relationship in the context of substance use disorder: A 15-month longitudinal study. Dev Psychopathol 2024:1-12. [PMID: 38282537 DOI: 10.1017/s0954579424000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This longitudinal study aimed to investigate the role of maternal cognitive functioning and psychopathology in parent-child relationship quality during residential treatment for mothers with Substance Use Disorder (SUD), in order to identify factors that may enhance or limit intervention effects.We assessed cognitive functioning (Esame Neuropsicologico Breve-2 [ENB-2]) and psychopathology (Symptom Checklist-90 Revised [SCL-90-R]) in 60 mothers diagnosed with SUD (Mage = 30.13 yrs; SD = 6.79) at treatment admission. Parent-child relationship quality was measured during free-play interactions using the Emotional Availability Scales every three months from admission (Child Mage = 17.17m; SD = 23.60) to the 15th month of the residential treatment.A main effect of maternal psychopathology and an interaction effect of time and cognitive functioning were found. More maternal psychopathology predicted lower mother-child relationship quality. Mothers with higher cognitive functioning presented a better treatment trajectory, with an increase in mother-child relationship quality, whereas mothers with lower cognitive functioning showed a decrease in relationship quality after initial improvement.These findings suggest that maternal psychopathology and cognitive functioning may influence the treatment of parent-child relationships in the context of SUD, although causality is not yet established. Implications for assessment and intervention are discussed.
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Affiliation(s)
- Alessio Porreca
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | - Pietro De Carli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, MI, Italy
| | - Bianca Filippi
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | | | - Marinus H van IJzendoorn
- Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, London, UK
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
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3
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Unlu H, Macaron MM, Ayraler Taner H, Kaba D, Akin Sari B, Schneekloth TD, Leggio L, Abulseoud OA. Sex difference in alcohol withdrawal syndrome: a scoping review of clinical studies. Front Psychiatry 2023; 14:1266424. [PMID: 37810604 PMCID: PMC10556532 DOI: 10.3389/fpsyt.2023.1266424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background We conducted a review of all studies comparing clinical aspects of alcohol withdrawal syndrome (AWS) between men and women. Methods Five databases (PubMed, Cochrane, EMBASE, Scopus and Clinical Trials) were searched for clinical studies using the keywords "alcohol withdrawal syndrome" or "delirium tremens" limited to "sex" or "gender" or "sex difference" or "gender difference." The search was conducted on May 19, 2023. Two reviewers selected studies including both male and female patients with AWS, and they compared males and females in type of AWS symptoms, clinical course, complications, and treatment outcome. Results Thirty-five observational studies were included with a total of 318,730 participants of which 75,346 had AWS. In twenty of the studies, the number of patients presenting with or developing AWS was separated by sex, resulting in a total of 8,159 (12.5%) female patients and a total of 56,928 (87.5%) male patients. Despite inconsistent results, males were more likely than females to develop complicated AWS [delirium tremens (DT) and AW seizures, collective DT in Males vs. females: 1,792 (85.4%) vs. 307 (14.6%), and collective seizures in males vs. females: 294 (78%) vs. 82 (22%)]. The rates of ICU admissions and hospital length of stay did not show sex differences. Although variable across studies, compared to females, males received benzodiazepine treatment at higher frequency and dose. One study reported that the time from first hospitalization for AWS to death was approximately 1.5 years shorter for males and males had higher mortality rate [19.5% (197/1,016)] compared to females [16% (26/163)]. Conclusion Despite the significant heterogeneity of the studies selected and the lack of a focus on investigating potential sex differences, this review of clinical studies on AWS suggests that men and women exhibit different AWS manifestations. Large-scale studies focusing specifically on investigating sex difference in AWS are needed.
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Affiliation(s)
- Hayrunnisa Unlu
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine Hospital, Ankara, Turkey
| | | | - Hande Ayraler Taner
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine Hospital, Ankara, Turkey
| | - Duygu Kaba
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine Hospital, Ankara, Turkey
| | - Burcu Akin Sari
- Department of Child and Adolescent Psychiatry, Baskent University School of Medicine Hospital, Ankara, Turkey
| | - Terry D. Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Translational Addiction Medicine Branch, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism, Baltimore, MD, United States
| | - Osama A. Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, United States
- Department of Neuroscience, Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine, Phoenix, AZ, United States
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4
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Melby K, Gråwe RW, Aamo TO, Skovlund E, Spigset O. Efficacy of Self-Administered Intranasal Oxytocin on Alcohol Use and Craving After Detoxification in Patients With Alcohol Dependence. A Double-Blind Placebo-Controlled Trial. Alcohol Alcohol 2020; 56:565-572. [PMID: 33352584 PMCID: PMC8406061 DOI: 10.1093/alcalc/agaa133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The aim of this study was to assess the efficacy of self-administered intranasal oxytocin on alcohol dependence after detoxification. Methods In a double-blind, randomized, placebo-controlled trial, 38 patients fulfilling the criteria for ICD-10 diagnosis of alcohol dependence received either 8 IU oxytocin or placebo at their own discretion up to thrice daily for 4 weeks, after completing detoxification. Primary outcome was alcohol intake specified as the amount of alcohol consumed, the number of days to relapse into alcohol use and the proportion of subjects relapsing. Secondary outcomes were self-reported symptoms of craving, sleep and mental distress. Results There were no significant differences between the oxytocin group and the placebo group in daily alcohol intake in total (mean 1.3 ± 2.9 vs. 2.0 ± 5.0 units; P = 0.63) or on drinking days (mean 8.4 ± 2.7 vs. 7.7 ± 6.0 units; P = 0.76), in the number of days until relapse (P = 0.91) or in the proportion of subjects relapsing (37.5 vs. 41.2%; P = 0.84). Neither were there any statistically significant differences in any other outcomes, except a larger decrease in self-reported nervousness in the oxytocin group (P = 0.022). Conclusion The results were inconclusive as to whether intranasal oxytocin reduced the time to relapse, degree of craving or total amount of alcohol consumed after detoxification. However, the oxytocin group had a larger decrease in self-reported nervousness.
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Affiliation(s)
- Katrine Melby
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Blue Cross Lade Addiction Treatment Centre, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf W Gråwe
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Research and Development, Division of Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Trond O Aamo
- Blue Cross Lade Addiction Treatment Centre, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Olav Spigset
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.,Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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5
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Balhara YPS, Singh S, Narang P. Effect of lockdown following COVID-19 pandemic on alcohol use and help-seeking behavior: Observations and insights from a sample of alcohol use disorder patients under treatment from a tertiary care center. Psychiatry Clin Neurosci 2020; 74:440-441. [PMID: 32463127 PMCID: PMC7283852 DOI: 10.1111/pcn.13075] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Swarndeep Singh
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Narang
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Bosse KE, Chiu VM, Lloyd SC, Conti AC. Neonatal alcohol exposure augments voluntary ethanol intake in the absence of potentiated anxiety-like behavior induced by chronic intermittent ethanol vapor exposure. Alcohol 2019; 79:17-24. [PMID: 30385201 DOI: 10.1016/j.alcohol.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/12/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022]
Abstract
Individuals fetally exposed to alcohol have a disproportionate risk for developing lifetime alcohol dependence, an association that may be confounded by the presence of comorbid conditions, such as anxiety. Anxiety is also observed following fetal alcohol exposure and is known to exacerbate ethanol consumption, highlighting the utility of animal models to assess this relationship. The present study evaluated the impact of third-trimester equivalent ethanol exposure on ethanol consumption and anxiety-like, marble burying behavior in adult, male C57BL/6 mice following exposure to chronic intermittent ethanol vapor, proposed to model dependence. Neonatal mice (P5-6, 2.5-3.0 g) were administered one injection of saline or ethanol (2.5 g/kg, subcutaneously [s.c.]). Pre-vapor marble burying and limited-access two-bottle choice ethanol intake (15% v/v, 2 h) were comparable in adults (8 weeks of age) across neonatal treatment groups. Five consecutive drinking sessions were repeated 72 h after each weekly ethanol vapor exposure procedure for a total of five vapor/drinking cycles. Consistent with prior research, an increase in voluntary ethanol drinking was observed in vapor-exposed, neonatal saline-treated mice throughout the study starting after the second vapor cycle compared to both air-exposed control groups. In neonatal ethanol-treated mice, this increase in ethanol intake and preference following vapor exposure was accelerated, being observed after the first vapor cycle, and observed at an augmented level compared to vapor-exposed, neonatal saline-treated mice and air controls for both neonatal conditions. Conversely, marble burying was enhanced equivalently in vapor-exposed mice from either neonatal treatment group relative to their respective air-exposed controls. These data recapitulate clinical observations of enhanced sensitivity for alcohol dependence following developmental alcohol exposure, which may reflect enhanced motivational drive rather than potentiated negative affect. The present model will facilitate the future exploration of mechanisms that underlie increased risk for alcohol use after early developmental exposure.
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Affiliation(s)
- K E Bosse
- Research & Development Service, John D. Dingell VA Medical Center, 4646 John R St., Detroit, MI, 48201, United States; Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St., Detroit, MI, 48201, United States
| | - V M Chiu
- Research & Development Service, John D. Dingell VA Medical Center, 4646 John R St., Detroit, MI, 48201, United States; Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St., Detroit, MI, 48201, United States
| | - S C Lloyd
- Research & Development Service, John D. Dingell VA Medical Center, 4646 John R St., Detroit, MI, 48201, United States; Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St., Detroit, MI, 48201, United States
| | - A C Conti
- Research & Development Service, John D. Dingell VA Medical Center, 4646 John R St., Detroit, MI, 48201, United States; Department of Neurosurgery, Wayne State University School of Medicine, 4160 John R St., Detroit, MI, 48201, United States.
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7
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Nalpas B, Perney P. Use of Psychoactive Medication in Short- and Long-term Abstainers from Alcohol. Alcohol Alcohol 2017; 52:447-452. [DOI: 10.1093/alcalc/agx018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
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Rose JH, Karkhanis AN, Chen R, Gioia D, Lopez MF, Becker HC, McCool BA, Jones SR. Supersensitive Kappa Opioid Receptors Promotes Ethanol Withdrawal-Related Behaviors and Reduce Dopamine Signaling in the Nucleus Accumbens. Int J Neuropsychopharmacol 2016; 19:pyv127. [PMID: 26625893 PMCID: PMC4886667 DOI: 10.1093/ijnp/pyv127] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/22/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic ethanol exposure reduces dopamine transmission in the nucleus accumbens, which may contribute to the negative affective symptoms associated with ethanol withdrawal. Kappa opioid receptors have been implicated in withdrawal-induced excessive drinking and anxiety-like behaviors and are known to inhibit dopamine release in the nucleus accumbens. The effects of chronic ethanol exposure on kappa opioid receptor-mediated changes in dopamine transmission at the level of the dopamine terminal and withdrawal-related behaviors were examined. METHODS Five weeks of chronic intermittent ethanol exposure in male C57BL/6 mice were used to examine the role of kappa opioid receptors in chronic ethanol-induced increases in ethanol intake and marble burying, a measure of anxiety/compulsive-like behavior. Drinking and marble burying were evaluated before and after chronic intermittent ethanol exposure, with and without kappa opioid receptor blockade by nor-binaltorphimine (10mg/kg i.p.). Functional alterations in kappa opioid receptors were assessed using fast scan cyclic voltammetry in brain slices containing the nucleus accumbens. RESULTS Chronic intermittent ethanol-exposed mice showed increased ethanol drinking and marble burying compared with controls, which was attenuated with kappa opioid receptor blockade. Chronic intermittent ethanol-induced increases in behavior were replicated with kappa opioid receptor activation in naïve mice. Fast scan cyclic voltammetry revealed that chronic intermittent ethanol reduced accumbal dopamine release and increased uptake rates, promoting a hypodopaminergic state of this region. Kappa opioid receptor activation with U50,488H concentration-dependently decreased dopamine release in both groups; however, this effect was greater in chronic intermittent ethanol-treated mice, indicating kappa opioid receptor supersensitivity in this group. CONCLUSIONS These data suggest that the chronic intermittent ethanol-induced increase in ethanol intake and anxiety/compulsive-like behaviors may be driven by greater kappa opioid receptor sensitivity and a hypodopaminergic state of the nucleus accumbens.
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MESH Headings
- Alcohol Drinking/adverse effects
- Alcohol Drinking/metabolism
- Alcohol Drinking/physiopathology
- Alcohol Drinking/psychology
- Alcohol-Induced Disorders, Nervous System/metabolism
- Alcohol-Induced Disorders, Nervous System/physiopathology
- Alcohol-Induced Disorders, Nervous System/psychology
- Analgesics, Opioid/pharmacology
- Animals
- Anxiety/metabolism
- Anxiety/physiopathology
- Anxiety/psychology
- Behavior, Animal/drug effects
- Compulsive Behavior
- Disease Models, Animal
- Dopamine/metabolism
- Dopaminergic Neurons/metabolism
- Dose-Response Relationship, Drug
- Ethanol
- In Vitro Techniques
- Male
- Mice, Inbred C57BL
- Narcotic Antagonists/pharmacology
- Nucleus Accumbens/drug effects
- Nucleus Accumbens/metabolism
- Nucleus Accumbens/physiopathology
- Receptors, Opioid, kappa/drug effects
- Receptors, Opioid, kappa/metabolism
- Substance Withdrawal Syndrome/metabolism
- Substance Withdrawal Syndrome/physiopathology
- Substance Withdrawal Syndrome/psychology
- Synaptic Transmission/drug effects
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Affiliation(s)
- Jamie H Rose
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Anushree N Karkhanis
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Rong Chen
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Dominic Gioia
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Marcelo F Lopez
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Howard C Becker
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Brian A McCool
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker)
| | - Sara R Jones
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Rose, Dr Karkhanis, Dr Chen, Mr Gioia, Dr McCool, and Dr Jones); Charleston Alcohol Research Center (Drs Lopez and Becker), Department of Psychiatry (Drs Lopez and Becker), and Department of Neurosciences (Dr Becker), Medical University of South Carolina, Charleston, South Carolina; RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina (Dr Becker).
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Giorgi I, Ottonello M, Vittadini G, Bertolotti G. Psychological changes in alcohol-dependent patients during a residential rehabilitation program. Neuropsychiatr Dis Treat 2015; 11:2989-96. [PMID: 26673839 PMCID: PMC4676624 DOI: 10.2147/ndt.s93520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive-affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse. MATERIALS AND METHODS The sample included 560 subjects (mean age 46.91±10.2 years) who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment - Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were identified and considered as outcome evaluation of the residential intervention. Moreover, differences in the psychological functioning between patients with different characteristics were investigated. RESULTS The score measured by the Cognitive Behavioral Assessment - Outcome Evaluation showed significant improvements in all the psychological characteristics assessed, and the profile at discharge was within the normal scores. Some significant differences were found in relation to specific characteristics of the sample, such as age, sex, level of education, type of intervention, and polysubstance use. CONCLUSION This study shows the changes in psychological profile in subjects undergoing residential rehabilitation from alcohol and how this profile may permit identification of subjects requiring more psychosocial support after discharge.
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Affiliation(s)
- Ines Giorgi
- Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, Italy
| | - Marcella Ottonello
- Department of Physical & Rehabilitation Medicine, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Genoa, Italy ; Department of Medicine, PhD Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome, Italy
| | - Giovanni Vittadini
- Alcohol Rehabilitation Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, Italy
| | - Giorgio Bertolotti
- Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Tradate, Italy
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10
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Goodson CM, Clark BJ, Douglas IS. Predictors of Severe Alcohol Withdrawal Syndrome: A Systematic Review and Meta-Analysis. Alcohol Clin Exp Res 2014; 38:2664-77. [DOI: 10.1111/acer.12529] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Carrie M. Goodson
- University of Colorado School of Medicine; Denver Colorado
- Denver Health Medical Center, Department of Medicine; Denver Colorado
| | | | - Ivor S. Douglas
- University of Colorado School of Medicine; Denver Colorado
- Denver Health Medical Center, Department of Medicine; Denver Colorado
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11
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Lyvers M, Carlopio C, Vicole Bothma H, Edwards MS. Mood, mood regulation, and frontal systems functioning in current smokers, long-term abstinent ex-smokers, and never-smokers. J Psychoactive Drugs 2014; 46:133-9. [PMID: 25052789 DOI: 10.1080/02791072.2013.876522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Indices of mood, mood regulation, and executive functioning were examined in 61 current smokers who have smoked daily for at least one year, 36 ex-smokers who had not smoked a cigarette for at least one year, and 86 never-smokers. All participants completed the following measures online: Depression Anxiety Stress Scales (DASS-21), the Negative Mood Regulation (NMR) scale, the Frontal Systems Behavior Scale (FrSBe), the Fagerström Test for Cigarette Dependence (FTCD), and the Alcohol Use Disorders Identification Test (AUDIT). Multivariate analysis of variance (MANOVA) followed by Tukey post-hoc tests revealed significant differences (p < .01) such that current smokers indicated worse functioning than both ex-smokers and never-smokers on DASS, NMR, and FrSBe, as well as heavier drinking as measured by AUDIT. These differences remained significant even after controlling for AUDIT scores. Results most plausibly reflect a return to pre-smoking baseline brain function in long-term abstinent ex-smokers.
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Affiliation(s)
- Michael Lyvers
- a Associate Professor, Department of Psychology , Bond University , Queensland , Australia
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12
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Schellekens AFA, de Jong CAJ, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry 2014; 30:128-36. [PMID: 24630346 DOI: 10.1016/j.eurpsy.2013.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse. SUBJECTS AND METHODS In a prospective design, male alcohol dependent patients (n=189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up. RESULTS One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse. CONCLUSION Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.
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Affiliation(s)
- A F A Schellekens
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA).
| | - C A J de Jong
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)
| | - J K Buitelaar
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands
| | - R J Verkes
- Department of Cognitive Neuroscience, University Medical Centre
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Patients' Improvements Measured With the Pleasant Activities List and the Community Reinforcement Approach Happiness Scale. ADDICTIVE DISORDERS & THEIR TREATMENT 2012. [DOI: 10.1097/adt.0b013e31820bfc67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Hibbert LJ, Best DW. Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys. Drug Alcohol Rev 2011; 30:12-20. [PMID: 21219492 DOI: 10.1111/j.1465-3362.2010.00190.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Many studies which assess functioning in recovering problem drinkers are limited to early recovery within inpatient or detoxification settings, or focus on relapse rates and treatment outcomes. This study assesses how functioning varies according to recovery stage and abstinence duration. DESIGN AND METHODS Fifty-three recovering problem drinkers participated from mutual aid groups or snowball recruitment. Cross-sectional interviewer-administered structured questionnaires assessed quality of life (QoL), self-esteem, self-efficacy, psychological and physical health. Participants could also self-complete the questionnaire. RESULTS Those in 'stable recovery' (5 or more years into recovery, n = 18) reported higher ratings of: three aspects of QoL--social relationships, psychological health, environment, as well as self-esteem (P < 0.05 for all variables) than those in 'early' (up to 5 years into recovery, n = 35). Depression was lower in 'stable recovery' (P = 0.027). Those in 'stable recovery' were more likely to live in their own home without professional support (P = 0.010) and have partners who had never been problem drinkers (P = 0.024). Overall, the continuous scores of many functioning variables correlated with abstinence duration indicating a continuous gain in functioning. DISCUSSION AND CONCLUSIONS Although limited by sampling considerations, this paper shows a gradual growth in functioning over a prolonged recovery process, and provides positive findings that those in recovery may expect to experience improvements in many areas of life as abstinence duration increases. For two aspects of QoL--environment and social relationships--functioning reaches a level above population norms offering hope of moving to a functioning level beyond the pre-morbid state.[Hibbert LJ, Best DW. Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys.
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Arnaud B, Malet L, Teissedre F, Izaute M, Moustafa F, Geneste J, Schmidt J, Llorca PM, Brousse G. Validity study of Kessler's psychological distress scales conducted among patients admitted to French emergency department for alcohol consumption-related disorders. Alcohol Clin Exp Res 2010; 34:1235-45. [PMID: 20477768 DOI: 10.1111/j.1530-0277.2010.01201.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol-related disorders (ARD) encountered in emergency departments (ED) have a high prevalence and are underestimated. It is necessary to provide professionals with a tool to identify patients in whom there is a risk that alcohol-related and mental health problems may be associated. Kessler's K6/10 psychological distress scales are fast, easy-to-use, and have been shown to achieve a good performance in the identification of psychological distress associated with ARD. AIM The aim of this study was to evaluate the psychometric properties of the Kessler scales, version 6 and 10, with a sample of patients admitted to EDs for alcohol consumption. METHODS On the day after their admission, with a zero "blood" alcohol concentration, 71 patients were randomly assigned to be assessed using 6 or 10 items version. The internal consistency and factor structure of the K6/10 versions were examined. Convergent validity was measured using the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Depression Rating Scale (HDRS). RESULTS The prevalence of psychological distress in our sample was approximately 60%. The selected threshold scores were 10 for K6 (Sensitivity: 0.92; Specificity: 0.62) and 14 for K10 (Sensitivity: 0.95; Specificity: 0.54). The Cronbach coefficients for K6 and K10 were 0.76 and 0.84, respectively. The factor analyses indicated the multidimensional nature of K6/10. The 2 versions, containing 6 and 10 items respectively, correlated better with the HADS (0.83 and 0.70, respectively) than with the HDRS (0.51 and 0.49, respectively). The areas under the ROC Curve indicated a high level of accuracy for both the K6 (0.87) and the K10 (0.77). The difference was not statistically significant. CONCLUSIONS This study confirms the good psychometric characteristics of Kessler's psychological distress scale. Even though similar performances were observed for K6/10, the brevity of the K6 makes it more suitable for use in EDs.
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16
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Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat 2009; 37:127-37. [PMID: 19150207 PMCID: PMC4864601 DOI: 10.1016/j.jsat.2008.11.007] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 10/29/2008] [Accepted: 11/24/2008] [Indexed: 12/16/2022]
Abstract
The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset of an alcohol use disorder, and higher treatment participation. Age moderated the association between depression and alcohol use and impairment such that the association was stronger in older samples.
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Affiliation(s)
- Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
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17
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Olgiati P, Liappas I, Malitas P, Piperi C, Politis A, Tzavellas EO, Zisaki A, Ferrari B, De Ronchi D, Kalofoutis A, Serretti A. Depression and social phobia secondary to alcohol dependence. Neuropsychobiology 2008; 56:111-8. [PMID: 18182831 DOI: 10.1159/000112952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 11/04/2007] [Indexed: 01/30/2023]
Abstract
BACKGROUND According to the self-medication hypothesis, individuals with depression and anxiety disorders use alcohol to control their symptoms and subsequently become dependent. Conversely, alcohol dependence disorder (ADD) can cause or exacerbate psychiatric disorders. This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder? METHODS Sixty-four inpatients with ADD were evaluated with depression and anxiety disorder scales upon admission to hospital and after 5 weeks of detoxification. RESULTS Baseline comparisons differentiated patients with a Hamilton Rating Scale for Depression (HDRS) score > 35 (n = 50; 78%) from those with an HDRS score < or = 35 by higher levels of generalized anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score > 60: n = 20; 31.2%] were not distinguishable from those with an LSAS score < or = 60 by depressive and anxiety disorder symptoms. In postdetoxification assessment, patients who remitted from depression (HDRS score < 7: n = 35; 54.6%) had a lower generalized anxiety and marginally higher levels of hypochondriasis compared to nonremitter subjects (HDRS score > or = 7). Patients who remitted from social phobia (LSAS score < 30: n = 32; 50%) did not significantly differ from nonremitter subjects in depressive and anxiety disorder symptoms. Generalized anxiety (Hamilton Rating Scale for Anxiety) and hypochondriasis (Whiteley Index) were the significant predictors of global functioning (Global Assessment Scale). CONCLUSIONS Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.
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Affiliation(s)
- Paolo Olgiati
- Institute of Psychiatry, University of Bologna, Bologna, Italy
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Kashkin VA, Zvartau EE, Fedorova OV, Bagrov YY, Lakatta EG, Bagrov AY. Endogenous bufadienolide mediates pressor response to ethanol withdrawal in rats. Eur Neuropsychopharmacol 2008; 18:74-7. [PMID: 17683916 PMCID: PMC2205993 DOI: 10.1016/j.euroneuro.2007.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 04/09/2007] [Accepted: 05/30/2007] [Indexed: 10/23/2022]
Abstract
An endogenous natriuretic and vasoconstrictor Na/K-ATPase inhibitor, marinobufagenin (MBG), is implicated in NaCl-induced hypertension and in ethanol addiction. In rats, MBG suppresses voluntary alcohol intake, while immunization against MBG induces alcohol-seeking behavior. Since alcohol withdrawal is associated with elevation of blood pressure (BP) and renal sodium retention, we hypothesized that MBG mediates pressor response to ethanol withdrawal. In male Sprague-Dawley rats, forced ethanol intake (20% v/v, 2.8+/-0.2 g/day for 7 days) did not affect BP and MBG excretion. Ethanol withdrawal was associated with a 21 mm Hg increase in BP, a 10% decrease in hematocrit, and a three-fold increase in renal MBG excretion. In vivo administration of anti-MBG antibody to rats prevented withdrawal-induced BP elevation. Therefore, MBG mediates pressor response to ethanol withdrawal, and may link mechanisms of ethanol dependence and hypertension.
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Affiliation(s)
- Vladimir A Kashkin
- Laboratory of Cardiovascular Science, National Institute on Aging/NIH, 5600 Nathan Shock Drive, Baltimore, MD 21224, USA
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19
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Coton X, Pinto E, Reggers J, Hansenne M, Parent M, Ansseau M. [Impact of personality on the alcohol withdrawal syndrome intensity: a preliminary study with the Cloninger's model]. Encephale 2007; 33:264-9. [PMID: 17675922 DOI: 10.1016/s0013-7006(07)92038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The personality of alcohol dependant patients as a factor influencing the intensity of the alcohol withdrawal syndrome has been seldom examined. Cloninger's biosocial model of personality describes four temperaments (novelty seeking, harm avoidance, reward dependence, persistence) which, except for persistence, are admittedly linked to specific central neurotransmitters, and three characters. Novelty seeking is linked with low levels of mesencephalic dopamine, harm avoidance with high levels of serotonin in the septo-hippocampic system and reward dependence with low levels of noradrenaline in the ascending pathways from the locus coeruleus to the limbic system. The same neurotransmitters pathways are known to be involved in alcohol withdrawal, with a decrease of dopaminergic activity in the mesolimbic system, a decrease of serotonergic activity in the nucleus accumbens and an increase of the noradrenergic system. In view of the similarities between the neurobiological systems involved in Cloninger's model and in the neurobiological changes occurring during the withdrawal period, one would expect to observe severe withdrawal symptoms more frequently for patients with high novelty seeking, low harm avoidance and low reward dependence. METHODS To test this hypothesis, alcohol dependent patients according to DSM IV classification criteria who have drunk in the last twenty four hours were included in the study and received a standardized withdrawal treatment. The withdrawal syndrome intensity was examined with repeated measures of CIWA-Ar, the scores of which were correlated with TCI-R. RESULTS Twenty eight patients, between 30 et 65 years old and drinking 22,2 +/- 12 standard drinks per day were included. Antidepressant drugs, benzodiazepines and neuroleptics treatment introduced before hospitalisation were stopped or decreased as much as possible. A correlation matrix was carried out between all the variables which could influence withdrawal intensity (age at the hospitalisation, age at the begining of the dependance, ratio between the time of the dependance and the patients' age, the number of alcohol withdrawals carried out and the number of standard drinks per day), and showed a positive correlation between the number of standard drinks per day and withdrawal intensity at day 3 (r=0.7, p<0.000), at day 4 (r=0.52, p<0.005), at day 7 (r=0.41, p<0.036) and at day 8 (r=0.44, p<0.02); as between the ratio between the time of the dependance and the patients' age and withdrawal intensity at day 2 (r=0.43, p<0.03) and at day 5 (r=0.5, p<0.01). Therefore, partial correlations were calculated between the dimensions of personality and withdrawal intensity. The study showed a positive correlation between withdrawal intensity and harm avoidance from day 5 onwards (r=0.6 and P<0.003 at day 5, r=0.59 and P<0.004 at day 6, r=0.56 and P<0.006 at day 7, r=0.66 and P<0.001 at day 8), a negative correlation between withdrawal intensity and reward dependence at day 7 and 8 (r=- 0.45 and P<0.037 at day 7, r=- 0.49 and P<0.02 at day 8) and a negative correlation between withdrawal intensity and persistence from day 6 onwards (r=- 0.5 and P<0.017 at day 6, r=- 0.5 and P<0.019 at day 7, r=- 0.51 and P<0.014 at day 8). No correlation was found between withdrawal intensity and novelty seeking. The same relevant results were found again with the 22 patients without anti-depressant drugs' population. DISCUSSION Personality dimensions seem to influence alcohol withdrawal intensity once the severe symptomatology is over, while high doses of anti withdrawal treatment in the first days of abstinence may decrease the influence of personality on withdrawal symptoms. The positive correlation between harm avoidance and withdrawal intensity seems to invalidate our neurobiological hypotheses, but can be explained by clinical observations and corroborate studies assessing the influence of personality in benzodiazepine withdrawal intensity and in pain perception. This result encourages the introduction of support therapy during withdrawal and a cognitive-behavioural therapy before withdrawal in order to decrease patients' sensitivity to anxiety. The negative correlation between reward dependence and withdrawal intensity confirms the neurobiological hypotheses, but the weak correlation demands to be cautious in the interpretation of the results. The negative correlation between persistence and withdrawal intensity was expected. CONCLUSION The characteristics associated with persistence seem to act as protective factors during alcohol withdrawal, whereas those associated with harm avoidance appear to increase the symptoms of alcohol withdrawal. In contrast, the neurobiological hypotheses are only partially confirmed.
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Affiliation(s)
- X Coton
- Clinique des Frères Alexiens, Henri-Chapelle, Belgique
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Wetterling T, Weber B, Depfenhart M, Schneider B, Junghanns K. Development of a rating scale to predict the severity of alcohol withdrawal syndrome. Alcohol Alcohol 2006; 41:611-5. [PMID: 16980710 DOI: 10.1093/alcalc/agl068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Various factors that may influence the severity of the alcohol withdrawal syndrome (AWS) have been identified. We tested the predictive value of these factors compiled in a newly developed scale, LARS (Luebeck alcohol withdrawal risk scale). METHOD A total of 100 individuals (81 males, 19 females, mean age: 47.6 +/- 9.9 years) consecutively transferred to inpatient detoxification were included in this prospective study. All fulfilled the ICD-10 criteria for alcohol dependence. The LARS was applied at the time of admission. The course of the AWS was assessed by AWS-scale at least every 4 h. The maximum AWS-score was taken as indicator of the severity of AWS. RESULTS The mean AWS-score(max) was 6.5 +/- 3.3. In all 20% of the patients developed a severe AWS (AWS-score(max) > or =10). The maximum score usually occurred within 36 h after the last drink. A short version, the LARS11, was developed by statistically grounded item reduction. The optimal cut-off of the LARS11 was calculated as 10. The positive predictive value for severe AWS was 76%, while the negative predictive value was 98.7%. The sensitivity and specificity were high (95 or 92.5%, respectively). CONCLUSION LARS11 assessed immediately before detoxification appears to provide a useful estimate of mild/moderate versus severe AWS, and is now ready to be validated in an independent sample.
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Affiliation(s)
- Tilman Wetterling
- Department of Psychiatry, Psychosomatics, Psychotherapy, JW Goethe University, Frankfurt, Germany.
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Abstract
<zakljucak> Sekundarna depresija u ranoj apstinenciji moze znacajno da utice na tok i ishod lecenja alkoholicara. Ona smanjuje kognitivne sposobnosti alkoholicara i njihovu saradnju pri lecenju uz mogucnost pojave teske depresije, suicida i recidiva. Grupa depresivnih alkoholicara je relativno mala subpopulacija primarnih alkoholicara, ali klinicki je vrlo znacajna. Pored redovnog programa za lecenje alkoholizma, ova grupa zahteva poseban terapijski pristup za depresiju sa kombinacijom farmakoterapije i psihoterapije. Prilikom prijema alkoholicara na lecenje bilo bi potrebno da se u rutinsku klinicku praksu uvede skrining na depresiju uz ponovnu dijagnosticku procenu posle cetiri nedelje radi distinkcije alkoholom indukovane depresije od sekundarne depresije. Lecenjem bi trebalo obuhvatiti ne samo sekundarnu depresiju teskog vec i depresiju umerenog i blagog stepena. Lecenje sekundarne depresije moglo bi popraviti ishod terapije alkoholizma i doprineti sprecavanju recidiva alkoholizma.
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Bruijnzeel AW, Gold MS. The role of corticotropin-releasing factor-like peptides in cannabis, nicotine, and alcohol dependence. ACTA ACUST UNITED AC 2005; 49:505-28. [PMID: 16269317 DOI: 10.1016/j.brainresrev.2005.01.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Revised: 12/06/2004] [Accepted: 01/24/2005] [Indexed: 11/26/2022]
Abstract
The corticotropin-releasing factor (CRF)-like peptides, which include the mammalian peptides CRF, urocortin 1, urocortin 2, and urocortin 3, play an important role in orchestrating behavioral and physiological responses that may increase an organism's chance of survival when confronted with internal or external stressors. There is, however, evidence that a chronic overactivity of brain CRF systems under basal conditions may play a role in the etiology and maintenance of psychiatric disorders such as depression and anxiety disorders. In addition, there is evidence of a role for CRF-like peptides in acute and protracted drug abstinence syndromes and relapse to drug-taking behavior. This review focuses on the role of CRF-like peptides in the negative affective state associated with acute and protracted withdrawal from three widely abused drugs, cannabis, nicotine, and alcohol. In addition, we discuss the high comorbidity between stress-associated psychiatric disorders and drug dependence. A better understanding of the brain stress systems that may underlie psychiatric disorders, acute and protracted drug withdrawal, and relapse to drug-taking behavior may help in the development of new and improved pharmacotherapies for these widespread psychiatric disorders.
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Affiliation(s)
- Adrie W Bruijnzeel
- Department of Psychiatry, University of Florida, McKnight Brain Institute, 100 S. Newell Dr. PO Box 100256, Gainesville, FL 32610, USA.
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Mandić-Gajić G. Possibility to predict the development of secondary depression in primary alcoholics during abstinence. VOJNOSANIT PREGL 2005; 62:833-9. [PMID: 16375207 DOI: 10.2298/vsp0511833m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The relationship between alcoholism and depression is observed in clinical trials. The factors which could predict persistence of secondary depression after alcohol withdrawal are not enough explored on admission. The differences between depressed (DA) and non-depressed (NDA) alcoholics regarding the degrees of severity of withdrawal, severity of depression and the intensity of cognitive dysfunctions were explored on admission to investigate possibility of prediction of the development of secondary depression in alcoholics. Methods. A group of primary male alcoholics (n=86) was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the DA group (n=43) and NDA (n=43) group according to the score on the Hamilton Depression Rating Scale (HAM-D). Clinical assessment of withdrawal, scoring on the Alcohol Dependency Severity Scale- ASD, and scoring on the Mini Mental Scale-MMSE were performed in all the participants on admission. The differences between the groups were tested by the Student's t-test. Results. The DA group showed the significantly higher severity of depression, higher levels of alcohol withdrawal symptoms and cognitive dysfunctions than the NDA group on admission. Conclusion. The specific group of depressive alcoholics was shown to be characterized by the higher severity of alcoholism and depression on admission, which could predict prolonged, secondary depression. Early detection and concurrent therapy of secondary depression could improve the treatment, and reduce the relapse of alcoholism.
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Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust 2004; 181:S29-46. [PMID: 15462640 DOI: 10.5694/j.1326-5377.2004.tb06352.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 02/27/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders. DATA SOURCES Systematic literature search using PubMed, PsycLit, and the Cochrane Library. DATA SYNTHESIS 108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. CONCLUSIONS The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.
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Affiliation(s)
- Anthony F Jorm
- Centre for Mental Health Research, Australian National University, Building 63, Eggleston Road, Acton, ACT 0200, Australia.
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